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Evidence-based Medicine

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Cognitive behavioral therapy and graded exercise therapy show promise for managing chronic fatigue syndrome

People with chronic fatigue syndrome (CFS) typically suffer from debilitating fatigue, headaches, disturbed sleep, difficulty concentrating, and muscle pain that often impair their ability to function. The cause of CFS remains unknown, but immunological, virological, psychological, and neuroendocrine factors have been suggested as possible causes. Health care professionals continue to debate appropriate ways to treat this problem.

A recent review of studies on CFS treatment concluded that cognitive behavioral therapy and graded exercise therapy had promising results. However, most of the studies had methodological problems that made it difficult to gauge the true impact of various treatments on patient outcomes.

More research is needed to better understand which treatments improve the health of CFS patients, suggests Cynthia D. Mulrow, M.D., M.Sc. Dr. Mulrow and colleagues at the San Antonio Evidence-based Practice Center (EPC) at the University of Texas Health Sciences Center conducted a systematic review of the evidence on managing CFS in adults. The EPC is supported by the Agency for Healthcare Research and Quality (contract 290-97-0012).

The researchers analyzed results of 36 randomized controlled trials and 8 controlled trials evaluating interventions to treat CFS in nearly 3,000 patients. All three trials evaluating graded exercise therapy found an overall beneficial effect compared with controls. Three of the four studies comparing cognitive behavioral therapy with controls also found an improvement in physical, psychological, or quality of life outcomes of CFS patients. All seven trials were considered quite valid. Treatment with either immunoglobulin or hydrocortisone showed some limited effects, but overall, the evidence was inconclusive. There was insufficient evidence to assess the effectiveness of medications ranging from antidepressants to ancyclovir; supplements (for example, essential fatty acids and magnesium); and complementary/alternative methods ranging from massage to homeopathic remedies.

See "Interventions for the treatment and management of chronic fatigue syndrome: A systematic review," by Penny Whiting, M.Sc., Anne-Marie Bagnall, Ph.D., Amanda J. Sowden, Ph.D., and others, in the September 2001 Journal of the American Medical Association 286(11), pp. 1360-1368.

Editor's Note: Copies of the Evidence Report/Technology Assessment No. 42, Defining and Managing Chronic Fatigue Syndrome (AHRQ Publication No. 02-E001) are available from the AHRQ Publications Clearinghouse.

A summary of the report (AHRQ Publication No. 01-E061) is also available from the AHRQ Publications Clearinghouse.

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